It's a rainy morning at White Center's public health clinic, and a pony-tailed little blonde, perhaps no older than three, is busy pushing and stacking big vinyl blocks on the floor.

Shaped like an egg carton and cheese, the blocks symbolize nutrition -- something the family planning clinic helps low-income parents maintain with federal food vouchers from the Women, Infants and Children program. As the girl plays, her young father keeps a watchful eye, at one point pulling the girl up in his chair and giving her a big kiss.

Across the lobby, a 38-year-old homeless woman with a velvet tunic wrapped round her head for warmth waits to be seen. She has been coming to the clinic for birth control since she was 15 and says the whole of White Center's mostly poor, mostly immigrant residents would be sorely out of luck if the county closes the clinic next June, as King County executive Ron Sims has proposed in his 2009 budget.

To meet a $93 million shortfall for 2009, Sims has proposed across-the-board cuts that include slashing $19.5 million from Public Health-Seattle & King County. That includes $11.5 million in permanent cuts as of Dec. 31 and another $8 million a year in what the county calls "lifeboat" services that would end June 30, when the White Center and Northshore family planning clinics would close and Public Health would end care for special needs children, an STD program for teens, and chronic disease care for seniors.

Among many other cuts, Public Health would also lay off three death investigators in the Medical Examiner's Office and reduce staff who follow up on those exposed to tuberculosis and other diseases.

Most of the permanent cuts involve program consolidation, such as reducing the immunization program from nine to four Public Health sites, with a total of 70 health workers to be cut in December and 69 slated for layoff next June.

The cuts are staggered, Public Health Director David Fleming says, to give the county six months to find funding and save the "lifeboat" services, most likely by going to the legislature, which is facing a $3.2 billion deficit of its own. With Public Health also slated to cut family planning at its Columbia City, Northgate, and Renton clinics in June, the next nearest site for county reproductive care and birth control would be downtown or Kent.

"Kent? How many buses do you gotta take to get there?" asks Kambarlee, 38, a disabled woman who lives outdoors near White Center. She requested her last name not be used.

The answer, says Nancy Rotecki, a nurse practitioner at White Center Public Health, is at least three buses, something that would be an ordeal for mothers with toddlers and strollers in tow. As a result, Rotecki says, many of her patients are likely to put off or forgo their reproductive care, leading to more unintended pregnancies and sexually transmitted disease.

That, she says, could financially stress some of the clinic's 2,600 patients, more than 60 percent of whom have no health insurance and depend on the clinic for birth control, maternity support, and well-baby care.

Like most of the extremely low-income people that Public Health serves, "these are non-paying clients. No one else will take them," Rotecki says. "There are no other clinics that can absorb these patients if the clinic closes."

For many, she says, the brief physical exam they get when they come in for an annual Pap smear is the only medical care they get, with Rotecki and other staff referring those who are sick to other clinics in the system. "It's going to be a huge loss for this community," she says -- one that Public Health's Fleming calls penny wise and pound foolish.

On Oct. 16, Fleming briefed the county Board of Health on the proposed cuts, saying that reducing preventive care will only lead to more disease and costly emergency room visits down the line, along with "bodies [that] may lie out for hours" because a death investigator isn't available.

"These are very, very serious reductions," Fleming said, that "from a social justice and equity standpoint are devastating."

The board passed a resolution identifying 12 possible funding sources that it's calling on the legislature to consider. Some are local taxing options that the county could use if the state allowed it; others are statewide taxing proposals that could help bail out all of Washington's ailing health departments.

If no funding is found, next year's cuts "could significantly affect health in King County and people's lives," County Councilmember Julia Patterson said.

"My biggest fear," she added," is that in the absence of a stable funding source, we will be right back here next year with a list [of cuts] that is even worse."